The impact and restoration of colorectal services during the coronavirus disease 2019 pandemic: A view from Oxford.

Aim: The coronavirus pandemic has significantly disrupted the way we deliver healthcare worldwide. We have been flexible and creative in order to continue providing elective colorectal cancer operations and to restart services for benign cases during the recovery period of the pandemic. In this paper, we describe the impact of coronavirus on our elective services and how we have implemented new patient pathways to allow us to continue providing patient care. Patients and Methods: Data on major colorectal elective resections were prospectively collected in an Enhanced Recovery After Surgery (ERAS) database. Data on the number of proctology cases and telemed appointments were collected from the hospital theatre information management system and electronic patient record system, respectively. Results: During the pandemic, there was a complete shift towards cancer cases, with benign services and proctology cases being placed on hold. Hospital length of stay was reduced. We implemented earlier hospital discharge and more intense telephone follow-up after elective major surgery. This has not resulted in an increase in postoperative complications, nor any increase in readmission to hospital. During the recovery phase, we have introduced a higher proportion of telemed consultations, including one-stop telemed proctology clinics, resulting in straight to tests or investigations. Conclusion: We have created a streamlined multidisciplinary pathway to reinstate our elective colorectal services as soon as possible and to minimise potential harm caused to patients whose treatment have been delayed. We anticipate many of these changes will be permanently incorporated into our clinical practice once the pandemic is over.

Creating awareness of the antegrade continence enema procedure and why nurses need to know about it.

The antegrade continence enema (ACE) procedure is mostly associated with children. Many children who underwent this are now entering adulthood and require expert advice and support from nursing and medical services. This article describes how a poster was created to make health professionals aware of this procedure and provide advice for troubleshooting. The type of flushing solution used for irrigation still seems to be selected by trial and error, depending on what suits each individual. There is little evidence in the literature on skin management for patients practising ACE, so it is pertinent to apply the best evidence available. Adult stoma care nurses will need a detailed understanding of this technique and management in the future, as it is likely that they will be called upon for support and advice.

The Kock pouch reconsidered: an alternative surgical technique.

The psychological impact stoma surgery can have on an individual is well documented within the literature (White and Hunt, 1997; Borwell, 2009; Williams, 2005; Brown, 2005). For many years, surgeons have explored and developed innovations in surgical techniques, in particular restorative procedures with a view of preventing permanent stoma formation; ileal anal pouch (IAP) now being the surgical procedure of choice for treatment of ulcerative colitis (UC) and familial adenomatous polyposis (FAP). However, high morbidity rates are associated with pouch longevity (Castillo et al 2005; Nessar and Wu, 2012) and once removed can lead to a high-output ileostomy with risks of electrolyte imbalance and malabsorption. This then creates the dilemma of whether the Kock pouch (KP) should be offered as a surgical option. This article offers a historical perspective of the KP and its place in the surgical management of UC and FAP. This article also presents results from a recent audit funded by the Ileostomy Association (IA), highlighting how patients manage their KP and the importance of maintaining bowel control and being free of an incontinent stoma as a means of coming to terms with their condition.

Colostomy irrigation: are we offering it enough?

This article discusses the use of irrigation for suitable colostomists and reasons why it can have a very positive effect on lifestyle. While it is evidence-based it also includes anecdotal tips from patients who irrigate. The suitability of patients to irrigate and ways to 'get started' with irrigation are discussed.